By Lawrence Diller, M.D. on January 18, 2009
Joseph Biederman, America's foremost child psychiatrist, and in the midst of a serious conflict of interest scandal, has agreed to temporary limitations in his role as director of Harvard's Massachusetts General Pediatric Psychopharmacology Clinic. Dr. Biederman, pending the outcome of an ongoing inquiry has "agreed to stop participating in several industry-funded trials" and "agreed not to participate in any outside activities that are paid for or sponsored by industry, such as consulting activities or speaking engagements," according to a statement released by the hospital.
Biederman has strongly pushed a biologic pro-psychiatric drug position on children' mental illness. Information garnered by Senator Charles Grassley's investigations and statements by Biederman uncovered in court related actions has revealed both undeclared drug company financial support to Biederman and commitments on his part to further the commercial interests of the drug giant, Johnson and Johnson. These reports threaten to topple Biederman, arguably psychiatry's most powerful voice on children, from his heretofore, untouchable Olympian heights. Meanwhile, Biederman, not surprisingly, has cried foul.
He says the drug company dollars (declared and undeclared) have not influenced him or his research. He claims his science and publications are "pure", supported by a peer review system that is supposed to verify accuracy and authenticity. Finally, he challenges as "office gossip" reports of his legendary anger and intolerance of those who disagree or don't support his proposals.
Ultimately, Biederman's self-defense betrays the same rigid ideology and personal patterns that have led to his current troubles. His situation, however, is emblematic of most of a very compromised medical research and academic community that has become dependent on industry money for its very existence.
It is true that the Biederman team has published thousands of psychiatric papers in peer reviewed medical journals. However, the most fundamental assumptions of any scientific model are often the most challengeable. All of his research exists on the shaky foundation guiding modern American psychiatry first described by the edition of Diagnostic and Statistical Manual of Psychiatric published in 1980 (DSM-III). With minimal research the DSM declared that "disorders" were categorical (either you "got it" or you don't) , specific and non-context based (only symptoms were important). While not stated, it was strongly implied that disorders were biological and genetic in nature.
Any front-line practitioner can tell you children's behavioral symptoms vary across a spectrum, rarely fit neatly into one diagnosis and are highly dependent on family, school and neighborhood environments. Yet the "science" of DSM, promoted by the Biederman team, has been a prime cause of the epidemic of ADHD, depression and now bipolar disorder identified in American children. With the diagnoses have come the widespread use of psychiatric drugs which lead to the next problem with Dr. Biederman's defense.
He says the drug companies didn't influence his research. Rather they came to him because of his research conclusions and prominent academic status. The latter is likely the case but Biederman's self-belief that he hasn't been influenced is highly suspect. Virtually all researchers say they are not influenced by drug company money. The influence may be subtle. Doctors rarely out and out lie about their research, but "spin" influences how a study is set up, its statistical analysis and interpretation. Research on drug studies repeatedly shows that drug trial results are tilted towards a positive description of the drug's effects when the research is funded by a drug company rather than the government or an independent agency.
Big Pharma money is most powerful when promoting Biederman's research and point of view over any competing models. Drug companies copy and mail his important papers on psychiatric drugs to every American physician working with children. A member of the Biederman team is at every important meeting on children's psychiatric issues and medical education. Their presence and often the conference, itself, are supported by drug industry dollars.
Questioning or contrary views, in comparison, get scant attention. Only when children die or side effects are severe -- as in the FDA hearings on children and antidepressants in 2004 and the recent publicity over obesity and diabetes caused by the bipolar drugs -- do opposing viewpoints get the country's eyes and ears. Biederman's conflict of interest problems have coincidentally exposed his strong pro-drug views to the public for scrutiny.
Finally, Dr. Biederman's personality and style are not irrelevant to America's children. There seems a ready supply of hubris and arrogance for those who have made it to the top of science's academic pyramids. Fear and intimidation of the Biederman team operate quietly on the small club of child psychiatric researchers. Only when two year olds started taking three psychiatric drugs simultaneously under a Biederman protocol for bipolar disorder did the emperor's clothes become so invisible as to begin the naming of names.
Business ethics, whose main concerns are profit and operating legally, collide with medical ethics which are directed to the patient's benefit, when academic research is dependent on industry money. A new set of rules have to be formulated and enforced to restore doctors' credibility. Long term, a surcharge or tax on trade medications could contribute to a general pool of research dollars but not designated for a particular industry sponsored drug. In the meantime, elements of Greek tragedy inform us to the broader problems highlighted by Dr. Biederman's travails.
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